Prognosis and histology in Stage I nasopharyngeal carcinoma (NPC).

During 1969-1975, 212 new patients with Stage I nasopharyngeal carcinoma (NPC) with a tumor apparently confined to the nasopharynx were treated at Queen Elizabeth Hospital, Kowloon, Hong Kong. The initial histologies of 137 patients were available for review and further studies. The primary tumors were histologically classified into two major types--squamous cell carcinoma (35 patients) and undifferentiated carcinoma (102 patients). The latter was further divided into 4 sub-types: lymphoepithelioma of the Schmincke type, lymphoepithelioma of the Regaud type, spindle cell carcinoma, and undifferentiated carcinoma of the nasopharyngeal type. Such histological typing of the initial tumor was not of value in predicting the clinical outcome, whether in terms of 5-year crude or disease-free survival rate, or the tendency of the tumor to develop recurrence at the primary site, or distant metastases after a standardized course of radiation therapy. There is no significant correlation between the extent of mononuclear infiltration nor fibrosis in the tumor stroma and the survival or tumor control rates.

The grooved nucleus. A useful diagnostic criterion of papillary carcinoma of the thyroid.

The optically clear nucleus has been recognized widely as an important histological feature of papillary carcinoma of the thyroid, and it is now considered by many workers as standing on an equal basis with the papillae for the diagnosis of this tumor. However, clear nuclei are sometimes patchy in distribution or absent in papillary carcinoma, and may be difficult to differentiate from pseudoclear nuclei which may be found in a variety of thyroid lesions. This study was undertaken to determine whether the grooving of the nuclei, a well-recognized electron-microscopic feature, can serve as an additional reliable light microscopic diagnostic criterion of papillary carcinoma. The histological sections of 103 consecutive cases of thyroid carcinoma, (including 89 cases of papillary carcinoma), 100 consecutive noncancer thyroidectomy specimens, and five cases of Hashimoto's thyroiditis were reviewed. Grooved nuclei were found in all cases of papillary carcinoma in almost every high-power microscopic field, and in the two cases of poorly differentiated thyroid carcinoma. Similar nuclei were found in only a very occasional field in four cases of adenoma, and one case each of multinodular goiter and Hashimoto's thyroiditis. We conclude that the deep grooving of the nuclei is a useful cytological feature for the diagnosis of papillary thyroid carcinoma.

Ovarian carcinoma metastasis to the breast case report and review of the literature.

Metastasis to the breast from extramammary malignancies is rare, but its recognition is important because the prognosis and treatment differ from that of primary breast cancer. We report a case of ovarian cancer with metastasis to the breast, which was found at the time of presentation. A 57-year-old woman presented with shortness of breath and was found to have a malignant pleural effusion. A right breast nodule contained papillary adenocarcinoma. Laparotomy showed bilateral ovarian papillary cystadenocarcinoma with dissemination in the peritoneal cavity. DNA image analysis showed multiple aneuploid stem lines. Immunohistochemical staining was positive with ovarian tumor marker OC125 but negative with breast tumor marker gross cystic disease fluid protein-15 (GCDFP-15) and estrogen receptor. The breast specimen was positive with OV632, a more specific tumor marker for ovarian cancer, thus favoring the ovary as the site of the primary tumor.

Extraskeletal chondroma with lipoblast-like cells.

An extraskeletal chondroma occurring over the dorsum of the wrist of a 61-year-old woman is reported. The lobulated tumor is cellular and shows mild-to-moderate nuclear pleomorphism of the chondroid cells. A unique feature is that some tumor cells are univacuolated and multivacuolated owing to accumulation of lipid, mimicking the appearances of lipoblasts.

Malignant lymphoepithelial lesion of the salivary gland.

Eight cases of malignant lymphoepithelial lesion (MLEL) of major salivary glands, seven of which occurred in Southern Chinese patients, are reported. All but two of the patients were older than 40 years of age; there were five male and three female patients. The parotid and submandibular glands were the sites of origin in equal numbers of cases. Six patients had elevated titers of serum IgA against Epstein-Barr virus capsid antigen. Seven remained well after surgery and local radiation therapy, and one died of miliary tuberculosis without evidence of residual neoplasm. Histologically, MLELs were characterized by syncytial clumps of large cells with vesicular nuclei and prominent nucleoli, admixed with abundant small lymphocytes and plasma cells. Two features not emphasized previously in the literature were the presence of reactive histiocytes in some epithelial islands, producing a starry sky pattern, and perineural invasion, which was identified in four cases. The tumor cells showed strong immunostaining for cytokeratin. The literature concerning this rare tumor is reviewed, and the differential diagnosis between MLEL and benign lymphoepithelial lesion, metastatic undifferentiated carcinoma, and malignant lymphoma is discussed.

Clear cell sarcoma of the penis.

The case of a 10-year-old boy in whom clear cell sarcoma occurred at the root of the penis is reported. The tumor cells were positive for S-100 protein, and ultrastructural examination showed the presence of melanosomes.

Sinonasal small cell neoplasm developing after radiation therapy for retinoblastoma: an immunohistologic, ultrastructural, and cytogenetic study.

Patients with retinoblastoma have an increased risk of developing second primary tumors. Only a few examples of sinonasal small cell neoplasms developing after radiation therapy for retinoblastoma have been reported. We report one such case that developed 18 years after treatment for retinoblastoma. Histologic examination revealed a small, blue, round cell tumor without rosettes or cytoplasmic glycogen. Immunohistochemically, the tumor cells were positive for neuron-specific enolase, synaptophysin, and S-100 protein, but negative for epithelial and mesenchymal markers, suggesting that this was a primitive neuroectodermal tumor. Cytogenetic studies of this tumor failed to reveal the chromosome 13 abnormality typical of retinoblastoma and the t(11:22) translocation typical of the group of peripheral neuroepitheliomas.

Accuracy and utility of differential white blood cell count in the neonatal intensive care unit.

The clinical utility of the complete blood cell count (including the differential white blood cell count) as a means to follow the course of infants in a neonatal intensive care unit was assessed. Utility was judged for three purposes: (1) predicting the onset of clinically unrecognized disease, (2) assessing the severity of current disease, and (3) following a trend during treatment. Neither conventional nor automated differential counts were useful for surveillance (predicting the onset of clinically unrecognized disease). The white blood cell count, the platelet count, and the absolute immature neutrophil count and immature/total neutrophil ratio were useful to assess the severity of current clinical events. The white blood cell count was superior to the differential count for following trends in patients' conditions. Information regarding nuclear immaturity derived from automated counts and the cost and slowness of the manual differential count are good indications for decreased use of conventional counts, increased use of certain features of the automated differential, or both, in neonatal intensive care units.

Comparison of assays for prostatic and total acid phosphatase.

Total and tartrate inhibited acid phosphatase was determined on the Technicon Chem 1 and evaluated against a Cobas-Bio centrifugal analysis procedure and an immunochemical method. Precision and reference range studies were performed for the Chem 1 acid phosphatase procedure and correlation was established with the other methods. The Chem 1 method for measuring total and prostatic acid phosphatase is a sensitive method with good correlation to the centrifugal analysis and the immunochemical method. The assay is fully automated and requires no manual off-line sample preparation.

Parotid swelling as the first manifestation of nasopharyngeal carcinoma: a report of two cases.

Nasopharyngeal carcinoma usually presents with enlargement of upper cervical lymph nodes, epistaxis, postnasal discharge, aural symptoms or cranial nerve palsy. Parotid swelling as the first and presenting symptom creates a diagnostic problem to both clinicians and pathologists. The authors report here two such cases to draw attention to this diagnostic problem and discuss the therapeutic implications.

Histiocytic necrotizing lymphadenitis (Kikuchi's disease) a clinicopathologic study of 9 cases.

The clinicopathological features of histiocytic necrotizing lymphadenitis in 9 patients are described. This disease occurs predominantly in the second and third decades of life, and in our series, is slightly more common in males. The commonest presentation is lymph node enlargement. Fever is also common, and was the mode of presentation in two patients. Laboratory investigations are non-contributory, with only an occasional case showing leucopenia or a raised erythrocyte sedimentation rate. The disease is self-limiting in all patients. The characteristic histological feature is the presence of pale nodules in the paracortex, consisting of a mixture of activated lymphoid cells, histiocytes and karyorrhectic debris. Granulocytes are strikingly absent.

Sinus histiocytosis with massive lymphadenopathy, a report of 2 cases in Chinese.

Two Chinese patients with sinus histiocytosis and massive lymphadenopathy are reported. The results of enzyme and immunohistochemical studies are presented.

Malignant fibrous histiocytoma of bone.

Malignant fibrous histiocytoma is a rare primary bone tumor, and there have been conflicting reports on its grades of malignancy. We are describing the cases of eight patients who were seen between 1977 and 1982. Four had pulmonary metastases and five, involvement of the lymph nodes. Five patients had a high level of serum alkaline phosphatase. None of the patients had a pathological fracture, an associated bone infarct, or Paget's disease. Seven of the eight patients died within one year after diagnosis.

Squamous cysts in renal dysplasia.

We report two cases of renal dysplasia with squamous cysts. The histological features in one case suggest that the cysts may develop through metaplasia of the tubular epithelium.

Malignant lymphoepithelial lesion of the parotid gland: a case report and review of the literature.

Malignant lymphoepithelial lesions are rare tumors of the major salivary glands. They most often occur in Asians and Greenland Eskimos and are strongly associated with Epstein-Barr virus infection. We report a case of a malignant lymphoepithelial lesion of the parotid gland that developed in an Italian-American woman whose serology was positive for Epstein-Barr virus antibody. The patient underwent a left total parotidectomy and upper neck dissection, followed by radiation therapy. At the 2-year follow-up, she remained free of disease.